Shan Zhenyu, Wang Xingsheng, An Le, Hang Chenchen, Jiang Zihao, Cheng Weijie, Zhong Ziqi, Shao Rui, Tang Ziren
Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
BMC Emerg Med. 2025 Jul 15;25(1):124. doi: 10.1186/s12873-025-01282-0.
Patients with out-of-hospital cardiac arrest (OHCA) suffer from hypoxia-ischemia and ischemia-reperfusion injury (IRI) after the return of spontaneous circulation (ROSC). The impact of early humoral immunity on prognosis in this process remains unclear.
Outcomes at discharge were evaluated in 183 patients resuscitated from OHCA, including neurological outcomes as measured by CPC scores, survival, and length of stay (LOS). Humoral immunity, including IgG, IgA, IgM, C3, and C4, was tested on the first day of admission. Difference test, restricted cubic spline, and correlation analysis were used to analyze the correlation between humoral immunity and outcomes.
Differences were observed in IgM, C3, and C4 levels among patients with different prognoses. Patients with poor prognosis have lower IgM levels (CPC 1-2 vs. CPC 3-5: 68.3[47.05-105] vs. 55.45[31.95-86.12] mg/dL, P = 0.0256), lower C3 levels (CPC 1-2 vs. CPC 3-5: 72.1[62.6-72.1] vs. 63.05[49.83-79.72] mg/dL, P = 0.0091; survival vs. dead: 72.1[60.9-86.62] vs. 58.7[43.7-72.6] mg/dL, P < 0.0001), and lower C4 levels (survival vs. dead: 18.9[15.38-22.92] vs. 17.2[11.85-21.5] mg/dL, P = 0.0148). Non-linear correlations were found between humoral immunity and prognosis (IgM: OR=1.068[95%CI: 1.009-1.130], P=0.0236); C3: OR=1.048[95%CI: 1.000-1.097], P=0.0488). LOS was negatively linearly correlated with IgG (R = 0.115, P = 0.0148) and C3 (R = 0.127, P = 0.0108) in patients with CPC 1-2.
Humoral immunity is at a low level in OHCA patients after ROSC, and humoral immunity was associated with neurological prognosis, survival at discharge, and LOS.
院外心脏骤停（OHCA）患者在自主循环恢复（ROSC）后会遭受缺氧缺血和缺血再灌注损伤（IRI）。在此过程中，早期体液免疫对预后的影响尚不清楚。
对183例从OHCA复苏的患者出院时的结局进行评估，包括通过CPC评分衡量的神经学结局、生存率和住院时间（LOS）。入院第一天检测包括IgG、IgA、IgM、C3和C4在内的体液免疫。采用差异检验、限制性立方样条和相关分析来分析体液免疫与结局之间的相关性。
不同预后患者的IgM、C3和C4水平存在差异。预后较差的患者IgM水平较低（CPC 1 - 2 vs. CPC 3 - 5：68.3[47.05 - 105] vs. 55.45[31.95 - 86.12] mg/dL，P = 0.0256），C3水平较低（CPC 1 - 2 vs. CPC 3 - 5：72.1[62.6 - 72.1] vs. 63.05[49.83 - 79.72] mg/dL，P = 0.0091；存活vs.死亡：72.1[60.9 - 86.62] vs. 58.7[43.7 - 72.6] mg/dL，P < 0.0001），C4水平较低（存活vs.死亡：18.9[15.38 - 22.92] vs. 17.2[11.85 - 21.5] mg/dL，P = 0.0148）。体液免疫与预后之间存在非线性相关性（IgM：OR = 1.068[95%CI：1.009 - 1.130]，P = 0.0236）；C3：OR = 1.048[95%CI：1.000 - 1.097]，P = 0.0488）。在CPC 1 - 2的患者中，LOS与IgG（R = 0.115，P = 0.0148）和C3（R = 0.127，P = 0.0108）呈负线性相关。
ROSC后OHCA患者的体液免疫处于较低水平，且体液免疫与神经学预后、出院生存率和LOS相关。
